Equity in access to health care services in Italy

Abstract

Objective: To provide new evidence on whether and how patterns of health care utilization deviate from horizontal equity in a country with a universal and egalitarian public health care system: Italy.

Data sources: Secondary analysis of data from the Health Conditions and Health Care Utilization Survey 2005, conducted by the Italian National Institute of Statistics on a probability sample of the noninstitutionalized Italian population.

Study design: Using multilevel logistic regression, we investigated how the probability of utilizing five health care services varies among individuals with equal health status but different SES.

Data collection/extraction: Respondents aged 18 or older at the interview time (n = 103,651).

Principal findings: Overall, we found that use of primary care is inequitable in favor of the less well-off, hospitalization is equitable, and use of outpatient specialist care, basic medical tests, and diagnostic services is inequitable in favor of the well-off. Stratifying the analysis by health status, however, we found that the degree of inequity varies according to health status.

Conclusions: Despite its universal and egalitarian public health care system, Italy exhibits a significant degree of SES-related horizontal inequity in health services utilization.

Figure 1

Global Analysis—For Each Health Care Service, the Figure Displays (a) the Marginal Median Predicted Probability (percent) of Utilization by SES: Point Estimates (Solid Lines) and 95 percent Confidence Limits (Dashed Lines); and (b) the Inequity Ratio: Point Estimate (White Circle), 50 percent Confidence Limits (Dark Gray Line), and 95 percent Confidence Limits (Light Gray Line)

Figure 2

Stratified Analysis of GP Visits—For Each Level of Health Status, the Figure Displays (a) the Marginal Median Predicted Probability (percent) of Utilization by SES: Point Estimates (Solid Lines) and 95 percent Confidence Limits (Dashed Lines); and (b) the Inequity Ratio: Point Estimate (White Circle), 50 percent Confidence Limits (Dark Gray Line), and 95 percent Confidence Limits (Light Gray Line)

Figure 3

Stratified Analysis of Outpatient Specialist Visits—For Each Level of Health Status, the Figure Displays (a) the Marginal Median Predicted Probability (percent) of Utilization by SES: Point Estimates (Solid Lines) and 95 percent Confidence Limits (Dashed Lines); and (b) the Inequity Ratio: Point Estimate (White Circle), 50 percent Confidence Limits (Dark Gray Line), and 95 percent Confidence Limits (Light Gray Line)

Figure 4

Stratified Analysis of Basic Medical Tests—For Each Level of Health Status, the Figure Displays (a) the Marginal Median Predicted Probability (percent) of Utilization by SES: Point Estimates (Solid Lines) and 95 percent Confidence Limits (Dashed Lines); and (b) the Inequity Ratio: Point Estimate (White Circle), 50 percent Confidence Limits (Dark Gray Line), and 95 percent Confidence Limits (Light Gray Line)

Figure 5

Stratified Analysis of Outpatient Diagnostic Tests—For Each Level of Health Status, the Figure Displays (a) the Marginal Median Predicted Probability (percent) of Utilization by SES: Point Estimates (Solid Lines) and 95 percent Confidence Limits (Dashed Lines); and (b) the Inequity Ratio: Point Estimate (White Circle), 50 percent Confidence Limits (Dark Gray Line), and 95 percent Confidence Limits (Light Gray Line)